Innervation of the Nipple-Areola Complex

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Abstract
The anatomy of the lateral cutaneous branch of the 4th intercostal nerve was anatomically and clinically determined, and correlated with postoperative sensation. Breast cadaver specimens (3) and 1 specimen after s.c. mastectomy were dissected. The nerve consistently penetrated into the posterior aspect of the breast. The point of reference was the intersection of the lateral border of the pectoralis major muscle with the 4th intercostal space. On the left breast this point corresponds to 4 o''clock and on the right breast this point corresponds to 8 o''clock. The nerve midway in its way to the nipple-areola complex divides into 5 fasciculi: 1 central to the nipple, 2 upper branches and 2 lower branches. The lowermost branch pierced the areola consistently at 5 o''clock on the left side and at 7 o''clock on the right side. Patients (20) underwent an augmentation mammaplasty. Ten patients were approached by a modified periareolar incision. Instead of the usual 9 to 3 o''clock incision, a 10 to 5 o''clock incision on the left breast and a 7 to 3 o''clock incision on the right breast was carried out. In the 10 remaining patients an inframmamary fold incision was utilized with blunt dissection and extreme care at the level of nerve penetration, with a partial skeletonization to ascertain its identity and the precise level of penetration. In 3 patients with gigantism an inferior lateral neural pedicle was designed. The postoperative sensation in 21 patients was similar to that preoperatively. Two patients following reduction mammaplasty had diminished sensation, which became normal in 2 wk. Patients (5) complained of moderate hyperesthesia in the nipple-areola complex, but this disappeared after 8 wk. Every surgeon operating on the breast should have knowledge of the anatomy of the lateral cutaneous branch of the 4th intercostal nerve.

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